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Caring for Older Adults with Disability: Lived Experience of Family Caregivers in Rural Thailand

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Caring for Older Adults with Disability: Lived Experience of Family Caregivers in Rural Thailand ABSTRACT CARING FOR OLDER ADULTS WITH DISABILITY: LIVED EXPERIENCE OF FAMILY CAREGIVERS IN RURAL THAILAND by Parnnachat Tipsuk The main purpose of this study was to understand the experiences and everyday life of family caregivers who are taking care of older adults in rural Thai villages. This study applied a phenomenological approach consisting of interviews with ten participants who willingly shared their personal experiences on caregiving to the elderly. Based on the findings, family caregivers experienced various feelings during their care duties. Those were 1) changing in their life path; 2) suffering alone; 3) double trouble; 4) disheartenment; and 5) the need for freedom. The justifications, which persuaded family caregivers continuing to undertake caring duties for disabled older adults were 1) compassion; 2) moral responsibility; 3) commitment; and 4) belief in the law of karma. The findings also revealed that the older adults who had an unhealthy relationship with his/her caregivers would not be provided with the best care. Many case studies shown people’s bias against caregiving for the elderly. This study highlighted some key recommendations, such as health resources, rewards, encouragement, and material assistance should be provided to family caregivers. The need for family-oriented mental health services should be developed and the more certain interventions should be made in support of the well-being of family caregivers in rural areas, especially among the aged spousal caregivers. The experience of family caregivers in urban areas and other regions should be conducted in future research. CARING FOR OLDER ADULTS WITH DISABILITY: LIVED EXPERIENCE OF FAMILY CAREGIVERS IN RURAL THAILAND A Thesis Submitted to the Faculty of Miami University in partial fulfillment of the requirements for the degree of Master of Arts by Parnnachat Tipsuk Miami University Oxford, Ohio 2016 Advisor: Pramote Prasartkul, PhD Reader: Chai Podhisita, PhD Reader: Jennifer Kinney, PhD ©2016 Parnnachat Tipsuk This Thesis titled CARING FOR OLDER ADULTS WITH DISABILITY: LIVED EXPERIENCE OF FAMILY CAREGIVERS IN RURAL THAILAND by Parnnachat Tipsuk has been approved for publication by The College of Arts and Science and Department of Sociology and Gerontology ____________________________________________________ Pramote Prasartkul, PhD ______________________________________________________ Chai Podhisita, PhD _______________________________________________________ Jennifer Kinney, PhD Table of Contents Chapter 1: Introduction……………………………………………………….………….…... 1 Introduction to the Problem………………………………………………….……….….. 1 Rational of the Study…………………………………………………………………....… 1 Purpose of the Study…………………………………………………………………….... 3 Statement of the Problem and Research Questions……………………………….….... 3 Definition of Terms………………………………………………………………….…..... 3 Chapter 2: Literature review…………………………………………………………………. 4 The Concepts of Caregiving……………………………………………………….......…. 4 Family Caregiving in Thailand…………………………………………………………... 5 Justification for Elderly Caregiving in Theoretical Perspective…………………….... 5 Research Related to the Life experiences of Caregiving…………………….………... 6 Conceptual Framework…………………………………………………………………… 8 Chapter 3: Research Methodology………………………………………………………….. 10 Research Method and Design………………………………………………………..…... 10 Setting………………………………………………………………………………………. 10 Participants…………………………………………………………………….................... 11 Summary of Demographic Characteristics of the Cases………………………………. 12 Materials and Data Collection…………………………………………………...……….. 13 Data Analysis Process…………………………………………………………………….. 13 Creditability………………………………………………………………………………... 14 Ethical Consideration…………………………………………………………................... 14 Chapter 4: Presentation of Findings……………………………………………………..….. 16 Summary of Caregiving Experience………………………………………………...…... 16 Emerging Themes………………………………………………………….…………….... 18 Chapter 5: Discussions and Conclusion…………………………………………..………… 32 Elderly-caregiving Experience………………………………………………………...…. 32 Phenomenological Description………………………………………………………...… 33 Social Exchange Theory Discussions……………………………………………......….. 35 Family Caregiving Trend in the Thai Contemporary Society………………......…….. 37 Summarizing the Study…………………………………………………………………… 38 Chapter 6: Implications and Recommendations………….………………………………... 40 Summarized Conclusion………………………………………………………………….. 40 Relevance and Significance of the Study……………………………………..…...……. 41 Implications and Recommendations…………………………………………………...... 41 Strength and Limitation…………………………………………...……………………… 42 References……………………………………………………………………...………. 44 Appendix A The Stories of the Family Caregivers……………………………….……….. 48 Appendix B The Brief Stories Related to Social Exchange Theory…………...……...…. 55 Appendix C Questions to Guide the Interview…………………………………………..… 57 iii List of Tables Table 1: Demographic Characteristics of Participants……………………………….......... 12 Table 2: Summary of Family Caregiver’s Experience…………………………………...... 16 iv List of Figures Figure 1: Conceptual Framework of the Study…………………………………….…..…... 9 Figure 2: Finding the Cases for Interviews…………………………………...…….......…... 11 Figure 3: A Summary of What It Feels Like to Be a Family Caregiver? ………..……… 18 Figure 4: A Summary of the Justification for Providing Care………………………........... 26 Figure 5: Factors Influenced to Elderly Care…………………………...………………..… 40 v Acknowledgements First of all, I am indebted to the National Research University (NRU) for awarding me the scholarship to pursue this master degree and to the Department of Sociology and Gerontology, Miami University - USA and Institute for Population and Social Research, Mahidol University - Thailand for all supports and fulfilled me invaluable knowledge about the subjects. The accomplishment of this thesis can be succeeded by the attentive support from my advisory professors - Professor Pramote Prasartkul, main advisor and Associate Professor Chai Podhisita, co-advisor. I deeply appreciates them for guidance in conducting and writing research, and their solicitude during I had a health problem. Especially, I would like to say “THANK YOU” million times to Professor Jennifer M. Kinney, my co-advisor, for her very kindness, encouragement, admiring words. This thesis could not have been possible if without her great attempt on copyediting and her useful recommendation to improve my thesis to be better. I thank my external examiner, Assistant Professor Suvinee Wivatvanit, for her great recommendation. Additionally, I would like to thank the entire respondents who were the sampling in this study. Essentially, I would like to thank my best friend, Ploychompu Sukustit, for all assistance – accompanying me to the study field and facilitating all studying process. I am indebted her. I would like to convey my sincere gratitude to my two supervisors - Associate Professor Sureeporn Punpuing and Saowapak Suksinchai for their great reinforcement. I thank my senior colleagues and favorable companions at IPSR– for boosting power during my weariness. Finally, all practicality of this thesis I dedicate to my father who passed away in 2003, and my mother who is patience in everything about my weird identity. Parnnachat Tipsuk vi Chapter 1: Introduction Introduction to the Problem A concern about population aging has become intense in Thai society for over the past two decades. As assumed by Knodel, Chamratrithirong, and Debavalya (1987), a successful implementation of a family planning campaign would rapidly lead to a higher percentage of senior people in the total population and simultaneously a decreasing number of caregivers for these elders. This assumption was supported almost twenty-five years later, when Thailand became an aging society (i.e., people aged 60 and over accounted for approximately 12 per cent of total population). As anticipated, the lack of caregivers for older adults has intensified. This is due to social changes, which influence caregiving patterns and attitudes of younger generation toward caring for older people. Traditionally, within the Thai cultural context, family members are the main care providers for aged parents. These providers are mostly spouses and adult children, mainly daughters and daughters-in-law (Knodel & Chayovan, 2011). The culture of elderly caregiving in Thailand is rather unique, based on the Buddhist ideology of “parent repayment” (Cafrey, 1992, p.117). Disregarding care of aging toward parents is seen as a disrespectful way and not a common practice. Cafrey (1992) explored caregiving for older adults in rural areas of Northeast Thailand, and reported three primary motivations for caregiving: 1) honoring the cultural norm of filial responsibility; 2) love or affection for the older adults; and 3) a desire to reciprocate for past attentions and to build up future merit for themselves. The practice of providing care for and supporting older adults has been passed down from generation to generation. As time goes by and concurrently socioeconomic changes, elderly caregiving situation has been challenging to Thai society because attitudes toward the elderly and caring patterns has grown progressively obscured. A recent study by Knodel et al. (2013) notifies that modernization has been affecting Thai family supports as the turndown of “intergenerational solidarity.” This phenomenon implicitly indicates the unstable pattern of traditional care of the elderly, implying a lack of kinship related caregiving in the future. Currently, there are few policies and actions
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